The Star – Small incisions, Improved results

Minimally invasive (keyhole) surgery, which uses a few small incision rather than one large incision, has been associated with better outcomes than open surgery, including fewer surgical site infections, less pain and shorted hospital stays. Today’s advanced procedures can also provide relief, prolong remission and postpone relapse, leading to improved quality of life.

Scarless thyroid surgery

Thyroid disorders/goitre are relatively common in the Malaysian population, especially among females. While there are often environmental, dietary and genetic factors that can contribute to the development of thyroid disorders, no actual cause can be found most of the time. The thyroid gland usually enlarges over a period of months to years. Patients would usually present to the clinic complaining of a neck swelling, either on one side (unilateral) or both sides (bilateral). If surgery is warranted, the commonest method is through an incision in front of the neck, leaving a 4cm to 6cm scar. There will be pain and tightness of the neck during the recovery period. Some people develop a thickened and sensitive keloid over the scar.

“However, with the combined use of fibre optic endoscopic telescopes and modern surgical instruments, it is now possible to remove small- and medium-sized thyroid glands through small incisions,” says Dr. Ong Kheng Wah, Consultant General Surgeon at Oriental Melaka Straits Medical Centre.

With these new techniques, certain benign thyroid swellings up to 4cm can be removed via the neck. “This is called endoscopic thyroid surgery – there is no scar in the neck, only two small scars hidden in the axilla and another 5mm scar at the areola of the breast,” explains Dr. Ong.

The smaller incisions are less invasive, less painful and result in finer scars. This operation is safe, achieves aesthetically pleasing scars and requires less analgesia. With a smaller incision and no wound across the neck, patients recover more easily and are able to return home and to work earlier.

Anti-reflux surgery

GERD (gastroesophageal reflux disease) develops when acid from the stomach flows back into the oesophagus due to a weakening of the lower oesophageal sphincter that does not function properly as a “one way” valve.

“Frequent episodes of GERD can lead to oesophagitis (inflammation of the oesophagus) and may even increase the risk of developing oesophageal cancer,” explains Dr. Yeap Chee Loong, Consultant General and Upper Gastrointestinal Surgeon at Oriental Melaka Straits Medical Centre.

Lifestyle modifications plus medication are often the first step to recovery. “Maintaining a healthy body weight is essential. Patients are taught to take small but frequent meals. They also shouldn’t lie down or sleep within three hours after meals. Avoiding alcohol, caffeine and cigarette smoking is also crucial,” advises Dr. Yeap.

If these methods do not work, anti-reflux surgery, called a fundoplication, can be a valuable option. The weakened sphincter is repaired and tightened by the surgeon by wrapping the upper part of the stomach around the lower end of the oesophagus. Considered a “small” surgery in more ways than one, this intricate procedure can be performed laparoscopically.

“Using laparoscopic techniques, this surgery can be done as a day-care procedure, allowing most patients to be safely discharged after a one-night stay in the hospital,” says Dr. Yeap.

The surgical option is useful for patients who do not show improvement with medications, patients who do not wish to be on long-term medication despite improvements of symptoms, and patients with extra-oesophageal symptoms such as sore throat, frequent asthmatic attacks and dental damage due to GERD. Other than the significant improvement of quality of life and symptoms that can be achieved, patients will also benefit from lower costs from needing less medication in the long term.